Julissa Quintanilla, PA-C
Individual provider Active NPI Physician Assistant · Faison, NC
NPI 1386487544 · NPPES record last updated Sep 23, 2024
Key facts
- NPI
- 1386487544
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 0010-14568 (NC)
- Practice address
- 444 SW Center St
Faison, NC 28341-8820 - Phone
- (910) 267-0421
- Fax
- (910) 378-1746
- NPI assigned
- Jun 17, 2024
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 5
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2024
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Goshen Medical Center Incorporated
Practice addresses (Care Compare)
444 SW Ctr St
Faison, NC 28341-8820
Phone (910) 267-0421
460 SW Ctr St
Faison, NC 28341-8820
Phone (910) 267-0951
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NC
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20241122000230 | NC | Practitioner - Physician Assistant | 2668907098 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Goshen Medical Center Incorporated | Current |
Accepting new patients | |
| Goshen Medical Center Incorporated | Current |
Accepting new patients | |
| Goshen Medical Center Incorporated | Current | Accepting new patients | |
| Goshen Medical Center Incorporated | Past | Accepting new patients |
Locations
444 SW Center St
Faison, NC 28341
Phone (910) 267-0421
Interoperability endpoints
- jquintanilla@goshenmedical.cloudcraftdirect.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Physician Assistant | 363A00000X | 0010-14568 | NC | Yes |
Addresses
Primary practice location
444 SW Center St
Faison, NC 28341-8820
Mailing address
PO Box 187
Faison, NC 28341-0187
Phone (910) 267-2042
Other providers in Faison, NC
- Lea Taylor Meeks
- Perla Mendo Lopez
- John Ralph Page
- Keith Patti
- Alice Petersen
- Randall Richards
- Renzo Santisteban
- Walter R Schmits Jr.
- Katheryn M Sican
- Sharon R Smith
All providers in Faison, NC · Physician Assistant in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 23, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.